CARE HOME ADULTS 18-65
Avis House Old Fallings Lane Fallings Park Wolverhampton West Midlands WV10 8DH Lead Inspector
Rebecca Harrison Key Unannounced Inspection 17th August 2006 09:35 Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Avis House Address Old Fallings Lane Fallings Park Wolverhampton West Midlands WV10 8DH 01902 866036 01902 866036 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alphonsus Homes Miss Helen Jones Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Learning Disability who may also have Physical Disability and under 65 years on admission The Manager must provide details of any conditions to be made or varied. 9th January 2006 Date of last inspection Brief Description of the Service: Avis House is a home providing accommodation, personal and nursing care to six people with a learning disability. It is one of twelve residential homes offered by Alphonsus Services and is situated in the Low Hill area of Wolverhampton, close to local shops and amenities. The home is purpose built and provides six single bedrooms with separate lounge and dining areas. There is adequate parking at the front of the building with a large garden at the rear. The aim of the home is ‘To ensure that each individual regardless of learning disability or physical disability are empowered to be as self managing as possible in all aspects of daily living including opportunities to express themselves, access community facilities, exercise choice and make decisions. To ensure that each service user is treated with respect, dignity, offered privacy and valued as an individual’. The exact fees charged per person were unknown however it was reported that the organisation has a block contract with the local authority to provide care and accommodation based on full occupancy. The age of the current people accommodated ranges from 54 – 86 years. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out over six hours. It included talking with service users, the manager, staff on duty, case tracking two service users, observing work practices, reviewing a number of records and a full tour of the home. 21 key National Minimum Standards for younger adults were assessed during this inspection in addition to standards 1 and 5 and a quality rating provided based on each outcome area for service users. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The service users, manager and staff on duty were welcoming and co-operated fully throughout the inspection. The purpose of this unannounced inspection was to review the three requirements made at the last inspection undertaken on 9th January 2006. No complaints have been received by the home or referred to CSCI since the last inspection and no referrals have been made under adult protection procedures. What the service does well:
People living at Avis House are supported by a committed and enthusiastic staff team. Staff interacted well with the people they support in a competent and professional manner and discussions held indicate that they had a clear understanding of service users individual needs. Staff reported that the service provided is to a high standard and were unable to identify any improvements required. The home is currently fully staffed and has no vacancies. Two service users spoken with were very complementary regarding the staff and manager and stated that ‘The staff are nice’ and ‘I really like the staff and like living here’. Service users continue to be provided with a comfortable, clean and homely place to live. The home was found well presented and offers spacious living accommodation to the people in residence. Bedrooms are personalised and reflect individuality. Contact with families and friends of the service users continue to be encouraged as much as possible. The majority of service users have regular visitors and the manager reported that a garden party in aid of charity is scheduled very shortly. People living at the home are provided with good opportunities to access the community and partake in activities appropriate to their needs.
Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The homes Statement of Purpose and Service User Guide need to be updated to reflect the new managerial arrangements in place. A large garden is provided to the rear of the property and the manager reported that she is intending to develop the garden to include a vegetable patch for people to grow fresh fruit and vegetables. The garden was found generally maintained however was in need of weeding. The homes procedures for the safekeeping of service users finances should be reviewed and two signatures be obtained for all financial transactions wherever possible. A planned programme of maintenance and renewal for the fabric and redecoration of the premises was not available and therefore needs to be developed to include the replacement of dining room curtains, identified carpets etc. A requirement was made at previous inspections for a sluicing disinfector be installed. The manager reported that she has sought advice from the Infection Control Nurse on an appropriate sluice and committed to purchasing this as a matter of priority. A team training plan has yet to be developed in addition to individual staff training records however the manager committed to developing these following staff appraisals. A training matrix was available and identifies that a small number of staff require refresher training in safe working practices.
Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users and their representatives have the information needed to choose a home and a contract, which tells them about the service they will receive. EVIDENCE: A Statement of Purpose and Service User Guide is in place and was displayed in the office. The manager committed to updating both documents in relation to the new managerial arrangements for the home. There have been no new admissions to the service for three years therefore it was not possible to assess key standard 2 on this occasion. Terms and conditions were available on both the care files reviewed. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning systems provide staff with sufficient information to ensure service users assessed needs are met. Service users are appropriately supported with decision-making processes and enabled to take responsible risks. EVIDENCE: Two service users were case tracked and their care files reviewed. A Community Care Assessment was available on each file. The home has a ‘Service Planning System’ in place, which provides staff with a brief history of the individual in addition to their individual support needs and an elderly care assessment. There was evidence that support plans are regularly reviewed by the home although it was reported that the placing authority has not formally reviewed any service user since the last inspection. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 11 Discussions held and observations made evidence that staff have a good understanding of the individual needs of the people they support and key workers are provided to ensure consistency and continuity of support. Daily records seen were comprehensive. Service users were provided with opportunities for making informed choices throughout the inspection. Although no independent advocacy service is currently available, it was reported that staff and the families of service users represent individuals who require any necessary support with decision making. Various risk assessments to support people with activities, moving and handling, tissue viability and maintaining a safe environment have been developed by the new manager and these were comprehensive on the two files reviewed. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a community presence. Family links are maintained, rights and responsibilities promoted and people provided with a varied diet in accordance with their personal preferences. EVIDENCE: The people accommodated at Avis House are unable to access paid employment or work experience and do not attend external day service provision, therefore day activities are now provided by the home. During the inspection two people were supported to go shopping and have lunch out in Wolverhampton using a variety of public transport. The people remaining in the home enjoyed a session of reminiscence supported by a member of staff. Interaction between the service users and staff member was constructive and appropriate to be the people present. Preferred routines were seen documented on the care files reviewed and observations made indicate that service users are supported to develop their
Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 13 independence as much as their ability allows. It was reported that one person assists with cleaning her room. Contact with families and friends of the service users continue to be encouraged as much as possible. The majority of service users have regular visitors and the manager reported that a garden party in aid of charity is scheduled very shortly. Menus seen indicate that people are provided with a balanced diet and adequate fresh fruit and vegetables were readily available. It was reported that the people accommodated do not currently have any special dietary needs although one individual continues to be closely monitored and was appropriately referred to a healthcare professional following a significant weight loss. Lunch was prepared by the staff on duty and service users were offered a choice of meal. The lunchtime was relaxed, unrushed and flexible and staff provided support to the individuals requiring assistance in an appropriate and sensitive manner. Preferences in relation to dietary needs and support requirements were seen on the two files reviewed in addition to a comprehensive record of foods eaten, which evidenced variety and choice. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs with evidence of regular review with healthcare professionals. The home has an effective system of handling, storing and managing medication. EVIDENCE: Personal support requirements were documented on the care plan reviewed and provide staff with basic information in addition to manual handling and Waterlow pressure sore assessments. Daily records ensure continuity of care is provided by all staff throughout a 24 hour period. Health appointment records were available on the files reviewed and evidence that individuals have regular access to NHS healthcare facilities and their rights to receive/decline treatment upheld and relevant referrals made to healthcare professionals. Accidents and incidents reports are appropriately recorded. Medication procedures appeared satisfactory at the time of the inspection. The home uses a Monitored Dosage System and only qualified staff administer medication. It was reported that staff have just enrolled to undertake
Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 15 accredited distance learning training on the administration and safe handling of medicines. None of the service users are currently prescribed controlled drugs although a facility for storage is available. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system in place and procedures to safeguard service users from potential abuse. EVIDENCE: A requirement was made at the previous inspection for the homes complaints procedure to include contact details of CSCI. This requirement has since been met and a copy seen displayed in the reception area. It was reported that no complaints have been received by the home since the last inspection and there have been no complaints referred to the Commission for Social Care Inspection. Discussions held with two service users evidenced that they had an understanding of whom to approach if they were unhappy with the service provided. The manager reported that she is in the process of making complaints in relation to recent events where two service users were provided with a poor service from two external services. Discussions with the manager regarding the events clearly evidence that she advocates for the rights of the people in her care. No referrals have been made under adult protection procedures since the service was last inspected. It was reported that the home has a nil restraint policy in place and it is not deemed necessary for staff to undertake training in physical intervention. The finances of the people case tracked were inspected and were an accurate reflection of the records held for one individual and ten pounds over for the other individual. Only the manager has access to service users finances and
Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 17 weekly financial checks are undertaken by the manager in relation to service users’ personal finances, day care and house keeping monies. Only one signature is currently obtained for service users transactions. The manager reported that she is attending a ‘training the trainers’ course in adult protection in September and following this course will then cascade this training to the team in relation to the local procedure. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are provided with a comfortable, clean and homely place to live. EVIDENCE: A full tour of the home was undertaken accompanied by the manager. The home was found well presented and offers spacious living accommodation to the people in residence. Bedrooms are personalised and reflect individuality. One persons bedroom has recently been redecorated and the choose her preferred colour scheme. A new carpet and curtains are to be purchased shortly. New furniture is also being provided for a further service user. A planned programme of maintenance and renewal for the fabric and redecoration of the premises was not available and therefore needs to be developed to include the replacement of dining room curtains, identified carpets etc. Bedroom doors are lockable however none of the people currently accommodated choose to use this facility. A quote has also been obtained to change a small room next to the office into a sensory room for the sole use of one service user who particulary benefits from using such equipment. A large garden is provided to the rear of the property and the manager reported that she is intending to develop the garden to include a vegetable
Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 19 patch for people to grow fresh fruit and vegetables. The garden was found generally maintained however was in need of weeding. The home was found clean and tidy throughout. A requirement was made at previous inspections for a sluicing disinfector be installed. The manager reported that she has sought advice from the Infection Control Nurse and obtained a quote and discussed this with her manager and committed to purchasing the required sluice as a matter of priority. Products hazardous to health are appropriately stored and data sheets available in addition to personal protective equipment, hand towels and soap. Documents are available to undertake infection control audits and the manager committed to allocating this responsibility to a staff member. It was reported that five staff have completed the distance learning course on infection control provided through Solihull College. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are safeguarded by the homes robust recruitment procedures and are supported by a committed, trained and enthusiastic staff team. EVIDENCE: Discussions held with a member of staff indicated that she was knowledgeable and had a clear understanding of the needs of the individuals accommodated. Throughout the inspection staff were observed to be accessible, good communicators and interacted appropriately with the service users. Staff spoke positively about their roles and responsibilities and appeared committed to their work. Staff commented that staff morale has improved with the support of the new manager who has motivated the team and developed confidence. Staff reported that the service provided is to a high standard and were unable to identify any improvements required. Two service users spoken with were very complementary regarding the staff and manager and stated that ‘The staff are nice’ and ‘I really like the staff and like living here’. The home provides six qualified nurses to include the manager in addition to twelve support staff. It was reported that four support staff hold NVQ awards and a further five staff are currently working towards the qualification.
Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 21 The personnel files of three permanent staff appointed since the last inspection were reviewed and found well presented and contained the relevant information as required by Schedule 2, of the Care Homes Regulations. The manager stated that the home has no staff vacancies. It was reported that thirteen staff are registered on LDAF awards and a new staff member spoken with confirmed that she received staff induction following her appointment. It was reported that the organisation has a training department based in Halesowen. The manager has obtained information on training events for the independent sector available from Beckminster House, Social Services and has identified a number of courses relevant to her team to include courses in dementia and is awaiting confirmation of booking. A team training plan has yet to be developed in addition to individual staff training records however the manager committed to developing these following staff appraisals. A training matrix was available and identifies that some staff require refresher training in safe working practices. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is effectively managed and promotes the health and safety of service users and staff. EVIDENCE: Ms Helen Jones is the manager of the home and her registration approved by CSCI on 05.07.06. She is a registered learning disability nurse and obtained NVQ level 4 Care, the Registered Managers Award and D32/33 Assessor award. She has numerous years experience within the learning disability field and since her appointment in January she has undertaken training courses appropriate to her role to include IOSH Managing Safety Course. Staff spoken with were complementary regarding the managers leadership skills. It was evident through observations made that she has developed positive working relationships with both service users and the team. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 23 A quality audit was undertaken by the organisation on 23.03.06 and the report was shared with the inspector and discussed. The manager reported that she has met the recommendations made. Questionnaires have been developed to distribute to service users, families and stakeholders on how the home is achieving goals for the people accommodated and the manager confirmed that questionnaires will be distributed at the forthcoming garden party and a report developed on the overal findings. Monthly visits and reports are undertaken as required under Regulation 26 and a copy of the report forwarded to CSCI as required. Health and safety procedures appeared satisfactory at the time of this inspection. A health and safety policy is available however this was not reviewed on this occasion. A health and safety audit is undertaken twice monthly and a maintenance log is maintained. Risk assessments, medical records, accident records, temperature monitoring charts and service certificates were reviewed and satisfactory. A risk assessment to support the use of bed rails was not available however the manager obtained an appropriate format specific to this equipment the day after the inspection and confirmed this with CSCI. The training matrix identified that a small number of staff are in need of refresher training in safe working practices, which the manager committed to ensuring that this be booked as a priority. It was reported that the neither the Fire Officer or the Environmental Health Officer have visited since the last inspection of this service. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 x 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23 Requirement A planned programme of maintenance and renewal for the fabric and redecoration of the premises must be developed and records kept. A sluicing disinfector must be installed for the safe disposal of body waste and to decrease the risk of cross infection and contamination This is outstanding from the four previous inspections and must be seen as a priority requirement. A team training plan and individual staff training and development assessments must be developed. The views of service users/representatives and stakeholders must be obtained and an annual development plan for the home developed. Timescale for action 31/10/06 2 YA30 13(3) 31/10/06 3 YA35 18(1)(c) 31/10/06 4 YA39 24 31/10/06 Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA23 Good Practice Recommendations It is recommended that service users records relating to their personal support requirements be more specific. It is recommended that the homes procedures for the safekeeping of service users finances be reviewed and two signatures be obtained for all financial transactions wherever possible. Avis House DS0000017179.V296543.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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